Series Overview

Rheumatologists are accustomed to monitoring liver function in patients receiving treatment for rheumatoid arthritis (RA), largely because of the risks associated with methotrexate (MTX). Now, after more than a decade of use, a clearer picture of the liver effects of biologic agents is developing. These effects appear to include a variety of uncommon toxicities such as the potential to activate latent tuberculosis (TB), demyelinating disorders, and certain neoplasms. On the other hand, evidence suggests that some biologics might offer the opportunity for benefit in the treatment of autoimmune and certain forms of viral hepatitis, in conjunction with standard antiviral therapy. These issues are at the forefront of new research into immune system biology. They formed the basis for an in-depth discussion between rheumatologist Dr. Leonard Calabrese and hepatologist Dr. Nizar Zein. This monograph is a detailed report of that discussion into the hepatic effects of biologic agents in the treatment of rheumatoid arthritis and their potential for the treatment of viral hepatitis.

Target Audience

Rheumatologists, rheumatology fellows, and other health care professionals who care for patients with rheumatoid arthritis.

Objectives

• Identify mechanisms underlying the role of cytokines in host-defense and propagation of liver disease.
• Adapt clinical decision making to new information about the relative risks and possible benefits of biologic therapy on forms of chronic hepatitis.
• Apply new screening and monitoring guidelines for the use of biologic therapy in patients at risk or affected by chronic liver disease.